In urology, there are two catagories of endoscopic instruments. The first category is diagnostic and is represented primarily by a cystoscope. The second category is operative which includes primarily the resectoscope and the visual urethrotome. The first category of instruments is not intended to include a manueverable part at the objective end of the instrument, that is, the end inside the patient. The instrument may have a catheterizing element, but its purpose is secondary to the observation purpose of the instrument and, consequently, the element is only poorly controlled and maneuvered.
The operative instruments, in distinction to the diagnostic instruments, include a working element which allows precise and controllable movement of a tool at the objective end of the instrument. In this fashion, the operative instrument provides for accurate cutting and fulguration inside the patient.
Because of the precision control with these endoscopic instruments, patients do not have to be cut open, and every year urologists perform several million operations, such as prostatectomies, removal of bladder tumors, removal of bladder stones, operations of the urethra, etc. In many of these situations, first a diagnosis is made using a cystoscope and at a later date the operation is performed. It has been common to give a general or spinal anesthetic at the time of the surgery. After the general anesthetic has taken effect, a resectoscope is introduced through the urethra and the operation is performed.
Because of the high cost of medical care, urologists are encouraged to perform certain of these operations on an out-patient basis, and if possible, under local anesthesia. The latter method not only reduces the cost of care by a considerable measure, but also removes the risk of a general or spinal anesthesia. Recently in endoscopic urological surgery, the application of local anesthesia has been facilitated by the introduction of an injection needle for use with a cystoscope. The cystoscopic injection needle is very helpful. Its application, however, is limited with the result that from a surgeon's point of view, the tool has numerous disadvantages. In particular, it is usable only with the observation instrument, that is, the cystoscope, with the result that there is very little maneuverability of the needle at the objective end of the instrument. Additionally, after application of the local anesthetic, it is necessary to remove the cystoscope from the patient and replace it with a resectoscope to perform the operative procedure of the operation. After the above multiple instrumentation and when the cutting and the fulguration has begun, if the anesthesia is not sufficient, or if additional areas of tissues are found that must be cut and burned, the resectoscope must be removed and the cystoscope reinserted to inject additional medication. Thereafter, naturally, the cystoscope again must be removed and the resectoscope again replaced in the patient. In this fashion, the patient's urethra may be severely tramatized. A further disdavantage is that the operator must hold the cystoscope with one hand and must direct the needle tip by way of the catheterizing element with his other hand. Since both hands are occupied, a second person is needed to inject the medication.
The cystoscopic injection needle is simply a hollow needle attached to a semi-rigid conduit element. The conduit element is attached to a luer lock for connection to a syringe. An injection needle in accordance with the present invention is not as simple, but it eliminates the disadvantages of the cystoscopic injection needle and, consequently, the indicated urological surgical method may be much simplified.